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Paediatrics Flashcards

1
Q

Tonsilitis?

A

Inflammation of the tonsils

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2
Q

Most common cause of tonsilitis

A

Viral infection

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3
Q

Most common cause of bacterial tonsillitis and most common alternative cause

A

Group A streptococcus (Streptococcus pyogenes)

Alternative is Streptococcus pneumoniae

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4
Q

Causes of bacterial tonsillitis (5)

A 
Streptococcus pyogenes
Streptococcus pneumoniae
Haemophilus Influenzae
Moraxella catarrhalis
Staphylococcus aureus
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5
Q

Name the areas of lymphoid tissue in Waldeyer’s Tonsilar ring

A

Adenoid
Tubal tonsils
Palatine tonsils
Lingual tonsils

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6
Q

Epidemiology Tonsilitis

A

Most common aged 5-10

Another peak at 15-20

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7
Q

Tonsilitis presentation (3) + (4)

A

Fever
Sore throat
Painful swallowing

Poor oral intake
Headache
Vomiting
Abdominal pain

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8
Q

Examination findings for tonsilitis

A

Red, inflamed, enlarged tonsils with/without exudates

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9
Q

What is the Centor criteria

A

Criteria estimating probability that tonsillitis is due to bacterial infection and will benefit from antibiotics

3 or more gives 40-60% bacterial tonsilitis

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10
Q

Centor criterias

A

Fever over 38
Exudates
No cough
Tender anterior cervical lymph nodes (lymphadenopathy)

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11
Q

Fever pain score?

A

Alternative to Centor criteria

2-3 gives 34-40%
4-5 gives 62-65%

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12
Q

Fever pain score criteria

A 
Fever during previous 24 hours
Purulence
Attended within 3 days of onset
Inflamed tonsils
No cough/coryza
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13
Q

Important conditions to exclude in tonsilitis

A

Meningitis, epiglottitis, peritonsillar abscess

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14
Q

Tonsillitis management

A

Educate viral tonsillitis patients with safety netting on when to seek advise

Advise simple analgesia, paracetamol, ibuprofen

Consider antibiotics if centor more than greater to 3 and Fever pain to 4 (Penicillin V/Phenoxymethylpenicillin 10 days)

If V pen allergic, give clarithromycin

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15
Q

Tonsillitis complications (7)

A 
Chronic tonsillitis
Peritonsillar abscess/quinsy
Otitis media
Scarlet fever
Rheumatic fever
Post-Streptococcal glomerulonephritis
Post-Streptococcal Reactive Arthritis
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16
Q

Quinsy?

A

Peritonsillar abscess - when there is bacterial infection with trapped pus, forming an abscess in the region of the tonsils.

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17
Q

Quinsy presentation (6) (3)

A 
Sore throat
Painful swallowing
Fever
Neck pain
Referred ear pain
Swollen tender lymph nodes

Trismus (unable to open mouth)
Change in voice (hot potato voice)
Swelling and erythema in area beside tonsils

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18
Q

Most common cause of quinsy (3)

A

Normally bacterial infection. Most common organism is Streptococcus pyogenes (group A strep), also commonly caused by Staphylococcus aureus and haemophilus influenzae.

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19
Q

Quinsy management (3)

A

Patients should be referred into hospital under the care of ENT team for incision and drainage of abscess under general anaesthetic.

Broad spectrum antibiotics (co-amoxiclav)

Some may give Steroids (Dexamethasone) to settle inflammation and help recovery

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20
Q

Tonsillectomy

A

Surgical removal of the tonsils

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21
Q

Tonsillectomy prevents tonsillitis?

A

Yes, but patients can still get sore throat.

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22
Q

Tonsillectomy complications (4)

A

Pain (Sore throat) lasts 2 weeks
Damage to teeth
Infection
Post-tonsillectomy bleeding

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23
Q

Tonsillectomy indications

A

Recurrent tonsillitis i.e.
7 or more in 1 year
5 or more in 2 years
3 or more in 3 years

Recurrent tonsillar abscesses (2 episodes)
Enlarged tonsils causing difficulty breathing, swallowing/ snoring

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24
Q

Post tonsillectomy bleeding management (6)

A

Call ENT registrar
Get IV access and send bloods including FBC, Clotting screen, Group and save and crossmatch
Keep child calm and give adequate analgesia
Sit child up and encourage to spit blood instead of swallowing
Make child nil by mouth (incase an anaesthetic and operation is required)
IV fluids for maintenance and resuscitation as required.

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25
Otitis media?
Infection in the middle ear
26
Where does the middle ear sit between
Tympanic membrane (ear drum) and inner ear.
27
How does bacteria infect the middle ear?
Bacteria enter from the back of the throat through the eustachian tube.
28
Timeline of otitis media?
Often preceded by viral upper respiratory tract infection
29
Otitis media cause (4)
Streptococcus pneumoniae (most common) Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus
30
Otitis media presentation (4)
Ear pain Reduced hearing General symptoms of upper airway infection (fever, coryzal, cough, sore throat) May also present with non-specific symptoms of poor feeding, vomiting, fever, irritability
31
Tympanic membrane in normal healthy child
Pearly grey, translucent and slightly shiny. Should be able to visualise malleus through the membrane and a cone of light reflecting the light of otoscope
32
Otitis media management (4)
Give simple analgesia to help with fever and pain Consider prescribing antibiotics at the initial presentation for patients (systemically unwell/immunocompromised) Consider delayed prescription that can be collected and used after 3 days if symptoms have not improved/worsened. First line antibiotics is amoxicillin for 5 days. Alternatives are erythromycin and clarithromycin.
33
Complications of otitis media (6)
``` Otitis media with effusion Hearing loss (usually temporary) Perforated ear drum Recurrent infection Mastoiditis (rare) Abscess (rare) ```
34
Glue ear?
Otitis media with effusion
35
How does glue ear occur?
When eustachian tube which helps drain secretions from middle ear becomes blocked.
36
Otitis media presentation (1)
Reduced hearing in affected ear
37
Otoscopy findings in otitis media
Dull tympanic membrane with air bubbles or a visible fluid level or could look normal
38
Glue ear management
Referral to audiometry to establish diagnosis and extent of hearing loss Usually resolves within 3 months Children with co-morbidities affecting ear structure (Down's Syndrome, Cleft palate) may require hearing aids/grommets
39
Hearing loss causes (3 branches) 3/2/4
Congenital Maternal rubella/CMV infection during pregnancy Genetic deafness Associated syndromes (Down's Syndrome) Perinatal Prematurity Hypoxia during/after birth ``` After birth Jaundice Meningitis/Encephalitis Otitis media/Glue ear Chemotherapy ```
40
Hearing loss examples of behaviour (4)
Ignoring calls/sounds Frustration/bad behaviour Poor speech and language development Poor school performance
41
Audiometry results in sensorineural hearing loss
Both air and bone conduction readings will be more than 20dB, plotted below the 20dB line on the chart.
42
Audiometry results in conductive hearing loss
Bone conduction will be normal (between 0 and 20dB) Air conduction readings will be greater than 20dB.
43
Audiometry results in mixed hearing loss
Both air and bone conduction readings will be more than 20dB, however there will be a difference of more than 15dB between the two (bone conduction>air conduction)
44
Hearing loss management (5)
``` SALT Educational psychology ENT Hearing aids for children who retain some hearing Sign language ```
45
Nose bleeds origin
Kiesselbach's plexus aka Little's area (area of nasal mucosa at front of nasal cavity that contains a lot of blood vessels.)
46
Triggers for nose bleeds
``` Nose picking Colds Vigorous nose blowing Trauma Change in weather ```
47
Advise and management for nose bleeds (3) (2) (1)
Sit up, tilt head forwards Squeeze soft part of nostrils together for 10-15 minutes Spit any blood in mouth out rather than swallowing Nasal packing using tampons or inflatable packs Nasal cautery using silver nitrate stick After treatment consider prescribing (naseptin) x4 10 days to reduce crusting, inflammation and infection
48
Cleft lip?
Congenital condition where there is split or open section of upper lip
49
Cleft palate?
Defect in hard/soft palate at roof of the mouth. This leaves an opening between the mouth and the nasal cavity.
50
Cleft lip palate complication (3)
Problems with feeding, swallowing and speech Psychosocial implications including bonding between mother and child Children with cleft palates more prone to hearing problems, ear infections and glue ear.
51
Management cleft lip palate (2)
First priority is ensuring baby can eat/drink (specially shaped teat bottles) Surgically correct the cleft lip/palate
52
Tongue tie?
Ankyloglossia. When baby is born with short and tight lingual frenulum
53
Tongue tie presentation
Prevents extension of tongue out of the mouth and makes it difficult for them to latch onto breast Presents as poor feeding
54
Tongue tie management
Frenotomy (cutting tongue tie)
55
Cystic hygroma
Malformation of the lymphatic system that results in a cyst filled with lymphatic fluid
56
Cystic hygroma typical location
Posterior triangle of neck on left side
57
Cystic hygroma mainly acquired?
No, most commonly a congenital abnormality. Can be seen on antenatal scans
58
Cystic hygromas presentation
Most commonly present in neck or armpit Can be very large, soft, non-tender, transilluminate
59
Cystic hygromas complication (3)
Can interfere with feeding, swallowing, breathing Can become infected There can be haemorrhage into the cyst
60
Cystic hygroma management (4)
Watch and wait Aspiration, surgical removal and sclerotherapy.
61
Thyroglossal cyst DDx
Ectopic thyroid tissue
62
Formation of thyroglossal cyst?
During foetal development, thyroid gland starts at the base of the tongue. From here it gradually travels down the neck to its final position in front of the trachea, beneath the larynx. It leaves a track behind called the thyroglossal duct. It normally disappears but when part of the duct persists it can give rise to a fluid filled cyst.
63
Features of thyroglossal cyst (5)
Mobile Non-tender Soft Fluctuant Can move up and down with movement of the tongue. This occurs due to connection between the thyroglossal duct and the base of the tongue.
64
Thyroglossal cyst investigation
Ultrasound/CT scan
65
Thyroglossal cyst management (1)
Surgically removed to provide confirmation of diagnosis on histology and prevent infections. Cyst can reoccur after surgery unless the full thyroglossal duct is removed.
66
Branchial cyst?
It is a congenital abnormality arising when the second branchial cleft fails to properly form during foetal development. This leaves a space surrounded by epithelial tissue which can fill with fluid.
67
Branchia cyst presentation
Round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck
68
Where do branchial cysts originate
Second branchial cleft
69
Branchial cyst management
Surgical excision Otherwise conservative management if no functional/cosmetic issues.

Prep for Phase 3A (6 decks)

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